Recently Approved Pharmacologic Agents to Improve Outcomes in Heart Failure

Traditional pharmacologic approaches to the management of patients with heart failure with reduced systolic function (HFrEF) have been based on neurohormonal inhibition on a background of hemodynamic effects. The agents that have been shown to be associated with improved outcomes in this patient population are inhibitors of the renin-angiotensin-aldosterone (RAAS) system, mineralocorticoids, and beta-blockers. More recently, two agents were FDA-approved for improved outcomes in HFrEF, sacubitril/valsartan, and ivabradine. Sacubitril/valsartan combines RAAS inhibition (valsartan) with inhibition of natriuretic peptide breakdown, while ivabradine is a novel means of heart rate control. While the evidence for clinical benefit of sacubitril/valsartan is substantial, evidence for the use of ivabradine is emerging.